First Chicago Corporation is the holding company for the First National Bank of Chicago, the eleventh largest bank in the United States. The corporation has 18,000 employees, 62% of whom are women. The average age is 36.6 years. Most of its employees are based in the states of Illinois, New York, New Jersey and Delaware. There are approximately 100 individual worksites ranging in size from 10 to over 4,000 employees. The six largest, each with over 500 employees (comprising in aggregate 80% of the workforce), have employee health units managed by the head office Medical Department in collaboration with the local manager for human resources. The small worksites are served by visiting occupational health nurses and participate in programs via printed materials, videotapes, and telephone communication and, for special programs, by contract with providers based in the local community.
In 1982, the company’s Medical and Benefits Administration Departments established a comprehensive Wellness Program that is managed by the Medical Department. Its goals included improving the overall health of employees and their families in order to reduce unnecessary health and disability costs as much as possible.
Need for Health Care Data
For First Chicago to gain any degree of control over the escalation of its health care costs, the company’s Medical and Benefits Departments agreed that a detailed understanding of the sources of expense was required. By 1987, its frustration with the inadequate quality and quantity of the health care data that were available led it to strategically design, implement and evaluate its health promotion programs. Two information system consultants were hired to help construct an in-house database which eventually became known as the Occupational Medicine and Nursing Information (OMNI) System (Burton and Hoy 1991). To maintain its confidentiality, the system resides in the Medical Department.
OMNI databases include claims for inpatient and outpatient health services and for disability and worker’s compensation benefits, services provided by the Bank’s employee assistance program (EAP), absenteeism records, wellness program participation, health risk appraisals (HRAs), prescription medications, and findings of laboratory tests and physical examinations. The data are analyzed periodically to evaluate the impact of the Wellness Program and to indicate any changes that may be advisable.
First Chicago’s Wellness Program
The Wellness Program comprises a broad range of activities that include the following:
- Health education. Pamphlets and brochures on a wide range of topics are made available to employees. A Wellness Newsletter sent to all employees is supplemented by articles which appear in the Bank’s publications and on cafeteria table cards. Videotapes on health topics may be viewed at the workplace and many are available for home viewing. Lunchtime workshops, seminars, and lectures on topics such as mental wellness, nutrition, violence, women’s health and cardiovascular disease are offered weekly at all major worksites.
- Individual counselling. Registered nurses are available in person to answer questions and provide individual counselling at the employee health units and by telephone to employees at the smaller worksites.
- Health risk assessment. A computerized health risk appraisal (HRA), including blood pressure and cholesterol testing, is offered to most new employees and periodically to current employees where there is an employee health unit. It is also offered periodically to employees of some satellite bank facilities.
- Periodic physical examinations. These are offered on a voluntary basis to management employees. Annual health examinations, including Pap smears and breast examinations, are available to female employees in Illinois. Mass screenings for hypertension, diabetes, breast cancer and cholesterol levels are conducted at worksites that have employee health units.
- Pre-retirement. Pre-retirement physical examinations are offered to all employees, starting at age 55 and continuing every three years thereafter until retirement. A comprehensive pre-retirement workshop is offered that includes sessions on healthy ageing.
- Health promotion programmes. Discounted fees are negotiated with community providers for employees participating in physical fitness programmes. Worksite programmes on prenatal education, smoking cessation, stress management, weight reduction, childhood wellness, cardiovascular risk factor reduction, and training for skin cancer and breast self-examination are provided at no cost.
- Cardiopulmonary resuscitation (CPR) and first aid training. CPR training is provided to all security personnel and designated employees. Infant CPR and first aid classes are also offered.
- Immunization programmes. Hepatitis B vaccination is offered to all health service workers who may become exposed to blood or body fluids. Foreign travellers are provided with immunizations, including routine tetanus-diphtheria boosters, as dictated by the risk of infection in the areas they will visit. Education is provided to employees on the value of flu shots. Employees are referred to their primary care physician or the local health department for this immunization.
Women’s Health Program
In 1982, The First National Bank of Chicago found that over 25% of health care costs for employees and their families were related to women’s health. In addition, over 40% of all employee short-term disability absences (i.e., lasting up to six months) were due to pregnancy. To control these costs by helping to ensure low-cost, high-quality health care, a comprehensive program was developed to focus on prevention and early detection and control of women’s health problems (Burton, Erikson, and Briones 1991). The program now includes these services:
- Worksite obstetrical and gynaecologic programme. Since 1985, the Bank has employed a part-time consulting gynaecologist from a major university teaching hospital at its home office in Chicago. Periodically, this service has been offered at two other locations and plans are in progress to establish the programme at another health service location. Voluntary annual health examinations are offered at the home office Medical Department to all female employees enrolled in the Bank’s self-insured benefit plan (employees electing enrolment in a health maintenance organization (HMO) may have these examinations carried out by their HMO doctors). The examination includes a medical history, gynaecological and general physical examinations, laboratory tests such as a Pap smear for cervical cancer, and other testing as may be indicated. In addition to providing examinations and consultations, the gynaecologist also conducts seminars on women’s health concerns. The worksite gynaecological programme has proven to be a convenient and cost-effective way to encourage preventive health care for women.
- Preconception and prenatal education. The United States ranks twenty-fourth among developed nations in infant mortality. At First Chicago, pregnancy-related claims accounted for about 19% of all health care costs in 1992 paid by the medical plan for employees and dependants. In 1987, to address this challenge, the Bank, in cooperation with the March of Dimes, began to offer a series of worksite classes led by a specially trained occupational health nurse. These are held during working hours and emphasize prenatal care, healthy lifestyles, proper nutrition, and indications for Caesarean section. On entering the programme, employees complete a pregnancy-related health risk appraisal questionnaire which is analysed by computer; both the women and their obstetricians receive a report highlighting potential risk factors for complications of pregnancy, such as adverse lifestyles, genetic diseases and medical problems. To encourage participation, female employees or spouses who complete the classes by the sixteenth week of pregnancy are eligible to have the 400 US$ deductible fee for the newborn’s health costs waived. Preliminary results of the prenatal education programme for employees in the Chicago, Illinois, area include the following:
- The Caesarean section rate is 19% for employees who participated in the worksite prenatal education programme compared to 28% for nonparticipants. The regional average Caesarean section rate is about 24%.
- The average cost of delivery in the Chicago, Illinois, area for employees who participated in the prenatal education classes was $7,793 compared to $9,986 for employees who did not participate.
- Absences from work for pregnancy (short-term disability) tend to be slightly reduced for employees who participate in the prenatal education classes.
- Breast feeding (lactation) programme. The Medical Department offers a private room and refrigerator to store breast milk to employees who wish to breast feed. Most employee health units have electric breast pumps and provide lactation supplies to employees in the Bank’s medical plan at no cost (and at cost to employees who are enrolled in HMOs).
- Mammography. Since 1991, mammography screening for breast cancer has been offered at no cost at employee health units in the United States. Mobile mammography units from fully accredited local providers are brought to all the six sites with employee health units from one to several times per year depending on need. Approximately 90% of eligible employees are within a 30 minute automobile drive of a screening mammography location. Female employees and wives of employees and of retirees are eligible to participate in the programme.
Employee Assistance Program and Mental Health Care
In 1979, the Bank implemented an employee assistance program (EAP) that provides consultation, counseling, referral, and follow-up for a wide range of personal problems such as emotional disorders, interpersonal conflict, alcohol and other drug dependencies and addictive disorders in general. Employees may refer themselves for these services or they may be referred by a supervisor who discerns any difficulties that they may be experiencing in performance or interpersonal relationships in the workplace. The EAP also provides workshops on a variety of topics such as stress management, violence and effective parenting. The EAP, which is a unit of the Medical Department, is now staffed by six full and part-time clinical psychologists. The psychologists are located at each of the six medical departments and in addition travel to satellite bank facilities where there is a need.
In addition, the EAP manages psychiatric short-term disability cases (up to six months of continuous absence). The goal of EAP management is to ensure that employees receiving disability payments for psychiatric reasons are receiving appropriate care.
In 1984, a comprehensive program was initiated to provide quality and cost-effective mental health care services for employees and dependants (Burton et al. 1989; Burton and Conti 1991). This program includes four components:
- the EAP for prevention and early intervention
- a review of the patient’s possible need for inpatient psychiatric hospitalization
- case management of mental health-related short-term disability by the EAP staff
- a network of selected mental health professionals who provide outpatient (i.e., ambulatory) services.
Despite enhancement of mental health insurance benefits to include 85% (instead of 50%) reimbursement for alternatives to inpatient hospitalization (e.g., partial hospitalization programs and intensive outpatient programs), First Chicago’s mental health care costs have dropped from nearly 15% of total medical costs in 1983 to under 9% in 1992.
More than a decade ago, First Chicago initiated a comprehensive wellness program with a motto—“First Chicago is Banking on Your Health”. The Wellness Program is a joint effort of the Bank’s Medical and Benefits Departments. It is regarded as having improved the health and productivity of employees and reduced avoidable health care costs for both the employees and the Bank. In 1993, First Chicago’s Wellness Program was awarded the C. Everett Koop National Health Award named in honor of the former Surgeon General of the United States.